Trusted Guide to Money

Let’s talk money – beyond the cash.

There are so many factors to consider when thinking about where to work as a nurse – ratios, unions, quality of life, etc. But one answer everyone wants to know is “how much money can I make?”

The answer, unfortunately, is not quite as simple as the question. Nursing is such a nuanced profession that the compensation varies greatly between cities, specialties, care settings, and facilities. What is really important when it comes to compensation, anyway? 

How much money you keep is likely much more important than how much money you can make.

There are places where nurses are paid top dollar but  in exchange must pay an arm and a leg to live in (hello San Francisco). But of course, we must also consider the economic concept of utility when thinking about total compensation.

And the questions don’t end there! Money is important. We constantly field questions:

“what is my take home?
how much will I make after taxes?
but what does it cost to live there?”

COMPENSATION

LOCATION

California Money

Where do nurses make the most money? When considering averages, California not only takes the cake but is a clean sweep in that it is also home to the top 4 paying metropolitan areas in the country: San Jose, Oakland, San Francisco, and Sacramento. Those, of course, come with a price tag (which we’ll get into below).

State runner ups are: Hawaii, Washington D.C., Massachusetts, and Oregon.

See below in terms of hourly/salary but keep in mind these are averages and there can be a ton of variability in these numbers!

CALIFORNIA: $49.37/$102,700
HAWAII: $46.63/$96,990
DISTRICT OF COLUMBIA: $43.32/$90,110
MASSACHUSETTS: $42.95/$89,330
OREGON: $42.68/$88,770

SPECIALTY

Not surprisingly, compensation can vary depending on your specialty. The general rule of thumb tends to be that the more specialized it is or specialty experience it requires, the higher the compensation. This is especially true for travel opportunities as they follow standard market supply/demand. In some places though, RNs are paid the same across the board regardless of specialty – which can be partly attributed to unions (see below).

Operating Room

Top paying specialties:
Operating Room (especially CVOR)
Cath Lab
Critical Care (especially pediatric)
Case Management/Utilization Review
Radiology/Interventional Radiology
Labor & Delivery

CLASSIFICATION

Temporary, staff, part-time, per diem, on-call, etc. One of the coolest things about our profession is that there are so many different ways (and frequencies) in which to do it!

Depending on your needs, one type of classification can be more ‘lucrative’ than another. Some staff nurses receive robust benefits – from highly discounted insurance, 401k, pension, or flexible sick and vacation time. But, if you don’t need all those benefits, going part-time or per-diem might be a better bet because the hourly compensation tends to be higher. If you value flexibility and experience, opting for a travel position will likely maximize your income for the periods of time that you are working, especially if you qualify for tax-free stipends.

THE OTHERS FACTORS

Shift: Depending on where you work, you can possibly make an extra pretty penny by working the less desirable shifts. For example, one hospital here in SF pays a 13% shift differential for night shift. So chronic night shifters make, on average, 13% more than their day shift counterparts!

Facility: Some facilities pay higher than others, for sheer purposes of attracting talent or because the nurses that work there are represented by unions. So be careful of making blanket assumptions that nurses working in a certain city or zip code are compensated the same!

BREAKING IT DOWN

Most clinical nurses are hourly employees. Unless you’re in a management, education, or an advanced practice position, you’ll likely be paid by the hour. So the amount of money you make is directly tied to how much time you put in (which is a good or bad thing depending on how you view it).

WAGES

In California, it is mandatory that employers that haven’t established an alternative work week compensate employees at 1.5x standard rate of pay for any hours over 8 worked in a day. For any time worked beyond 12 hours in a day, it is 2x standard rate of pay, or double-time. This can mean that picking up an extra shift or staying a few hours beyond your shift can be extremely lucrative.

For travel nurses, whose taxable rates, or standard rates of pay, tend to be lower, the overtime or double time multiplier is applied to a much lower number. This can translate to travelers being less incentivized to work overtime, as it’s not nearly as advantageous.

STIPENDS

Some employment classifications, such as travel contract opportunities, may enable nurses to qualify for tax-free stipends. This qualification is discussed further in the Trusted Guide to Travel Nurse Taxes. Stipends for nurses typically come in three forms: lodging, meals and incidents, and relocation.

The amount of stipends paid for lodging and meals and incidentals are also called per diems and are determined by the government based on zip code. These amounts can be found at GSA.gov and indicate the daily maximum allowance for each category and reflect the cost of living in that particular area.

Relocation stipends can cover reimbursable expenses incurred when relocating for employment. These stipends are also tax-free.

BONUS

‘Bonus’ has such a good reputation: sign-on bonus, completion bonus, extension bonus, referral bonus, etc. Everyone loves a bonus – especially the IRS. Bonuses are typically categorized as supplemental wages and thus get taxed in 1 of 2 ways: via the Percentage Method or the Aggregate Method. Regardless of which applies, you’ll be paying taxes on that bonus at a potentially higher tax rate than your regular wages AND depending on the amount of the bonus, it may bump you into a higher tax bracket.

Hey, we all know taxes are painful, but money is money and even taxable money is almost always more beneficial than no money, or bonus! Just be sure to set your expectations to avoid being bummed when that bonus doesn’t look as good in your bank account as it did on paper!

COST OF LIVING

If you come from a smaller or suburban town, you might experience a touch of sticker shock when you start looking for housing in city where the cost of living is astronomically higher, such as San Francisco, New York City, Philadelphia, etc. While these numbers may scare some away from popular cities like San Francisco, where there is a will, there is a way! Before taking one glance at the rent and immediately being discouraged, consider that salaries and wages tend to be tied to the cost of living. There are definitely affordable options within and around each of these cities. There may be commutable places close by that have a more reasonable cost of living – especially if the position only requires commuting three times a week.

Let’s be real – it’s pretty uncommon that someone chooses the nursing profession for the compensation. But that doesn’t mean that it can’t be extremely rewarding in a financial way as well!

Sarah Gray
Sarah is a Pediatric Clinical Nurse III at UCSF Benioff Children's Hospital and a UCSF 2017 Evidence Based Practice Fellow. A New Jersey native, Sarah graduated from Penn Nursing and has been living in San Francisco ever since. She's been an athlete her whole life and continues to be passionate about health, fitness, and making the most of all opportunities. She continues to harness her passion for innovation and process improvement in her role as Founding Clinician at Trusted Health.